Provider Demographics
NPI:1851110951
Name:HENDRICKS, PEYTON GRACE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PEYTON
Middle Name:GRACE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2080 ENERGY DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-8722
Mailing Address - Country:US
Mailing Address - Phone:919-328-5573
Mailing Address - Fax:984-235-1617
Practice Address - Street 1:2080 ENERGY DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8722
Practice Address - Country:US
Practice Address - Phone:919-328-5573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant